Immunization Policy Statement

Immunization is a vital public health tool and one of the most cost-effective means of public health promotion and disease prevention. Vaccines prevent disease, disability, and death in children and adults. Sustaining high vaccine coverage levels in children and adolescents, increasing coverage rates in adults, and incorporating new vaccines into the routinely recommended immunization schedule requires vigilance and adequate resources.

I. EVIDENCE BASED STATE AND TERRITORIAL POLICY

State laws mandating vaccines are one strategy to control vaccine preventable disease. Enacting vaccine requirements for entry into schools, day cares, and universities is a state and territorial responsibility. Currently, all states and territories require documentation of vaccination for school entrance; however, there is variability in the types of exemption (medical, religious, or philosophical) accepted. State and territorial health agencies (S/THAs) also focus on vaccination requirements for personnel and patients in healthcare settings and correctional facilities. ASTHO supports the following:

The right for S/THAs to individually consider vaccine laws and regulations, employ a rigorous evidence-based decision-making process that seeks input from experts and the public, and pursue appropriate policies and legislation. The adoption of easy-to-attain exemptions for vaccine requirements is inconsistent with good public health policy and contrary to efforts to improve vaccine coverage.

The right of S/THAs to have the flexibility to tailor the implementation of evidence-based strategies for increasing vaccination uptake and reducing vaccine hesitancy to meet the needs of local and regional populations.

The development of immunization laws and reporting based on the recommendations made by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP).

II. QUALITY ASSURANCE AND ACCOUNTABILITY

S/THAs have the primary responsibility for ensuring vaccine accountability systems are in place for publicly funded vaccine programs. To accomplish this mission, S/THAs will often conduct clinical office visits to ensure appropriate vaccine storage and handling practices, and identify opportunities to improve vaccination coverage within the general population. ASTHO supports the following:

The right for S/THAs to maintain a careful balance between program requirements, reporting requirements, and maintaining provider participation.

The use and improvement of technology systems to maintain or advance accountability within immunization programs.

The development and maintenance of vaccine stockpiles to ensure adequate supply, encourage vaccine rotation, and extend product shelf-life without compromising product stability or efficacy, in an effort to ensure vaccine is not wasted.

III. VACCINE FINANCE

Federal funding for vaccines can be grouped into two programs: the Vaccines for Children program (VFC), which provides funding for the purchase of vaccines for eligible children, and the Section 317 Immunization Grant Program, which provides funding for infrastructure and the purchase of vaccine for those who would otherwise not have access to immunizations. A number of states or territories have additional programs to support the provision of vaccines. ASTHO supports:

Enhanced, stable funding to support public health infrastructure necessary for the vaccine delivery system, meet the increasing cost of vaccines, and provide safety-net coverage for those without adequate healthcare coverage.

Vaccine financing policies that recognize the value of vaccines and provide adequate compensation for vaccines and vaccine delivery, as well as incentives for continued vaccine research and development. Vaccine billing systems that allow states and localities to bill well-insured children, adolescents, and adults served in the public sector.

Sustaining adequate funding for the Section 317 vaccine purchase program and the Vaccines for Children program to provide vaccine for those without healthcare coverage and those whose healthcare coverage is inadequate.

Sustain the Section 317 infrastructure program to provide the core immunization functions that facilitate an efficient and effective immunization enterprise. These functions include immunization information systems, accountability, and reaching vulnerable populations among others.

Federal funding for immunization programs distributed to state, territorial, and local grantees in the most equitable manner, with recognition that existing programs should not be weakened. Funds should be distributed based on four criteria: need, capacity, performance, and population, according to a methodology developed with state and territorial input.

IV. VACCINE ACCESS AND DELIVERY

S/THAs play an important role in building strong partnerships to ensure that vaccines are accessible. Children and adolescents should receive immunizations in the setting that is linked to their primary healthcare, and often this optimal location is the medical home. S/THAs recruit and train networks of vaccine providers to assure access to the VFC program, and promote the use of proven strategies to improve vaccination coverage through materials, training, and visits to clinical sites. ASTHO supports the following:

Evidence-based strategies to improve and sustain immunization coverage levels that can be adapted to state, territorial, tribal, and local needs.

Health policy decisions and immunization goals based on the most comprehensive data available, including the use of multiple national surveys. The National Immunization Survey (NIS) is the most cost-effective tool currently available for measuring state-by-state and territorial vaccine coverage levels and needs enhanced federal funding to measure coverage levels for the expanded child and adolescent immunization schedule. ASTHO supports timely release of data from the NIS.

S/THAs partnerships with alternative providers within the immunization neighborhood (e.g., pharmacies, schools, workplace, and other clinical sites) to support suitable alternative venues for vaccination, recognizing that every child may not be reliably linked to a healthcare provider.

Strategies to improve and sustain adult and adolescent immunization coverage.

Support of the new revised National Adult Immunization Practice Standards.

Research to determine optimal coverage levels for newly recommended vaccines and to assess the barriers to reaching optimal levels. Data should be used in the development of programs and interventions to improve coverage levels.

Research to assess the impact of the increased coverage rates for immunizations from the Affordable Care Act. Research to identify continued gaps in coverage and best options for addressing them.

V. VACCINE SAFETY AND EFFECTIVENESS

Public health implements several different approaches to monitor vaccine safety and effectiveness. After a vaccine is licensed in the United States, public health experts review epidemiologic data to ensure that vaccines are working properly and are safe. This system is in place to protect the public and ensure that primary care providers offer safe and effective vaccines to their patients. ASTHO supports the following:

The periodic reassessment of the National Vaccine Injury Compensation program and the Vaccine Injury Table to determine their adequacy and appropriateness, and maintain that any changes should be made in consultation with the S/THAs. Information explaining the risks and benefits of vaccine and the availability of compensation for vaccine-related injuries must be developed by the federal government and distributed in a timely manner through effective and appropriate education efforts by all entities and providers delivering vaccine.

The continued study of vaccines and the development of safety improvements in vaccines and vaccine delivery techniques.

The continued emphasis on development of appropriate vaccine safety, vaccine hesitancy, and risk communication messages.

Research to ensure the safety of vaccines, to evaluate the effectiveness of vaccine delivery strategies, and to better understand the transmission of disease.

Incentives and policies to encourage vaccine development and ensure a stable, adequate, and safe vaccine supply.

VI. VACCINATION RELATED TO BIOTERRORISM PREPAREDNESS

ASTHO supports the collaboration of federal, state, territorial, and local public health agencies to work together to advance national security goals and address public health risks by formulating policies that include the vaccination of certain populations for a potential bioterrorism attack. Implementation of bioterrorism preparedness vaccination programs should include clear communication about the threat of the organism in question, along with the risks and benefits of vaccination; liability protection for those administering the vaccine; compensation for injuries caused by the vaccine; standard consent and data collection forms when and where feasible, and, under certain warranted emergent circumstances, use of Emergency Use Authorization provisions as provided for by federal statute; and additional resources and funding flexibility.

VII. VACCINATION DURING AN INFLUENZA PANDEMIC OR PUBLIC HEALTH EMERGENCY

Much of the response to emerging disease outbreaks is carried out by public health agencies at the local and state level. At every step, public health works closely to improve public awareness of disease transmission and risk reduction. During emergencies, vaccine must be effectively allocated, distributed, and administered. The needs and capacities of states and territories differ. ASTHO supports the following:

The collaboration of federal, state, territorial, local, and tribal governments to develop an effective and coordinated pandemic vaccination plan.

Vaccine targeting, in the event that vaccine is not immediately available to everyone during a pandemic, to maintain security, healthcare, critical infrastructure, and essential community services, and to protect at-risk populations and workers at occupational risk of infection with the ultimate goal of immunizing everyone who chooses to be immunized.

The development of guidance on the allocation and targeting of pandemic influenza vaccine that is evidence-based and reflects input from the government, stakeholders, and the general public.

The flexibility to implement a pandemic response plan and vaccine targeting guidance tailored to meet the specific needs of local and regional populations.

Vaccine availability and planning should include access to a vaccine supply so that state, territorial, local, and tribal governments are able to provide an appropriate response to a routine outbreak of a vaccine-preventable disease.

VIII. IMMUNIZATION INFORMATION SYSTEMS

Immunization information systems (IIS) are confidential, computerized systems that contain vaccination histories and provide authorized providers immediate access to the immunization status of children and adults. The benefits of IIS include improved office efficiency, reduction of over-immunization, integration of additional public health services, and easier identification of persons at risk in the event of a disease outbreak or other public health emergency. ASTHO supports the following:

The development, continued use, and further improvement of IIS to assist in integrating several program strategies, including vaccine management, accountability, quality assurance and delivery, consumer information, surveillance, adverse events tracking, and assessment.

The IIS information exchange between authorized users in different states and localities.

The integration of IIS with electronic health records to facilitate information exchange between private providers and public health.

Approval History:

Access Policy Committee Review and Approval:Board of Directors Review and Approval: December 2014Ratified by the ASTHO Assembly of Member: December 2014Policy expires: December 2017

ASTHO policies are broad statements of enduring principles related to particular policy areas that are used to guide ASTHO's actions and external communications.